N. Texas doctors developed guidelines to determine what to do if hospitals are overwhelmed

The patients most likely to benefit from care would get priority.

As physicians, we are constantly asked by both laypeople and health care professionals about the COVID-19 pandemic. Fear is in the air, especially when we are asked who will receive intensive care services if demand exceeds supply.

People express rational fears about treatment for differently enabled, minority, elderly and all other socially disadvantaged communities routinely subjected to discrimination in our society. Our society does not distribute health care resources equitably in ordinary times, and our own lieutenant governor recently implied it might just be better for the elderly to die.

After the 2003-04 SARS epidemic, medical, civic and governmental groups across the country asked: What if SARS or the 1918 Spanish flu happened now, and we didn’t have the capacity to provide hospital or intensive care support for every person who might seek it?

In response, the Dallas County Medical Society created the North Texas Mass Critical Care Council. Through the hard work and wisdom of many medical and civic leaders from four counties (Dallas, Tarrant, Collin and Denton), the council created guidelines for a time when demand exceeds supply. We explored not only issues of clinical science, but culture, faith and ethical issues like personal autonomy, responsibility and distributive justice. The guidelines were then translated into hospital and health care system guidelines with two purposes: To save as many lives as possible and to prohibit discrimination in delivery of services.

For example, here is the anti-discrimination statement from the Baylor Scott & White Hospital version of the guidelines: “Each patient will receive respect, care, and compassion without regard to basis of race, ethnicity, color, national origin, religion, sex, disability, veteran status, age, genetic information, sexual orientation, gender identity or any other protected characteristic under applicable law.”

During a time of overwhelming demand for hospital services, access to treatment would be based upon the patient’s ability to benefit from it, using objective physiologic criteria. Doctors would rely on the sequential organ failure assessment score, or the SOFA score.

SOFA scoring is an international assessment standard, calculated using objective measurements of things like lung, heart, liver and kidney function. Medical factors, rather than social criteria, guide the physicians’ judgment about which patients are most likely to benefit from ICU interventions when there are not enough ICU services for every patient. This saves as many lives as possible.

Based on SOFA scores, doctors might determine that an elderly patient with a mild case of COVID-19 is more likely to recover using a hospital ventilator than a young patient whose organs have been overwhelmed by the virus, or vice versa, but the decision would be based entirely on whether the treatment is likely to help the patient recover.

Doctors are prohibited from considering social status, money or other nonmedical criteria when determining how to care for patients. We don’t get special access because we are physicians, nor does the chief executive of any hospital, nor does any mayor or county commissioner.

The county medical societies and hospitals in North Texas have all pledged to follow these regional guidelines. We hope and pray we will not need to activate the full guidelines, but we are worried that the time will come, and thus our desire for our entire North Texas community to understand the guidelines in advance.

There are some who say doctors shouldn’t make any choice about resource allocation, but simply practice first-come-first-served medicine. That is an approach we considered, but the best evidence we have indicates more lives would be lost and more discrimination would occur. In health care, we see both the best and the worst of human behaviors. We believe that following communitywide guidelines is the best defense we can offer against the worst of human behavior, not only to disadvantaged communities, but to every member of our community.

During ordinary times, but especially during hard times, goodness in the world is not solely dependent on the acts of leaders. Goodness in the world also depends upon individual acts of everyday kindness, compassion and love of one’s fellow human beings.

Goodness in the world is dependent upon each of us seeing ourselves as part of a larger community attempting to serve and save as many people as possible. Goodness in the world is dependent upon all of us working together.

Dr. Robert Fine is co-chair of the North Texas Mass Critical Care Council. Dr. Mark Casanova is president of the Dallas County Medical Society. Dr. John Carlo is co-chair of the North Texas Mass Critical Care Council. They wrote this column for The Dallas Morning News.